Pediatrics International最新文献

Background: Patients discharged from the intensive care unit (ICU) often experience high morbidity rates. The aim of the present study was to estimate the incidence of functional capacity impairment in pediatric patients who were discharged from the ICU in a middle-income country and to identify associated factors, considering the socioeconomic context.

Methods: This was a multicenter cohort study of 357 patients aged <18 years admitted to three ICUs in the interior cities of São Paulo State. The Functional Status Scale was used to assess the patients at admission, ICU discharge, and hospital discharge. New morbidity was defined as a change in any domain of the scale equal to or greater than two, or a change in the total score equal to or greater than three. A multiple logistic regression model was used to identify independent associations with new morbidity.

Results: New morbidity occurred in 14.6% and 12.3% of patients at ICU and hospital discharge, respectively, compared with those at admission. The feeding (p < 0.001) and respiratory (p = 0.036) functional domains were the most affected at ICU discharge. The risk factors associated with new morbidity at hospital discharge were heart disease, older age, longer ICU stay, and higher PELOD2 severity score.

Conclusions: To reduce the risk of new functional morbidity, healthcare teams should be attentive to the critically ill pediatric population, particularly those who are older and have chronic clinical conditions, especially heart disease.

Background: Moraxella species are commensal organisms of the upper respiratory tract that only occasionally cause invasive infection. Pediatric Moraxella bacteremia is extremely rare, and its clinical features and optimal management remain poorly defined.

Methods: We conducted a single-center, retrospective observational study at Tokyo Metropolitan Children's Medical Center. Patients with blood cultures yielding Moraxella spp. between April 2010 and March 2024 were identified. Clinical and microbiological data were extracted from electronic medical records. The primary outcome was all-cause 28-day mortality.

Results: Among 24 patients (28 episodes) with blood cultures positive for M. catarrhalis or M. osloensis, 13 episodes were excluded as contamination. Eleven patients (15 episodes) with confirmed bacteremia were analyzed: 8 episodes were due to M. osloensis and 7 to M. catarrhalis. Two patients had recurrent episodes (one patient with congenital nephrotic syndrome had four episodes of M. catarrhalis bacteremia). Overall, 10 of 11 patients (91%) had underlying immunodeficiency. Central venous catheters were present in 6 of 8 M. osloensis episodes, which were classified as catheter-associated bacteremia. In the M. catarrhalis group, pneumonia was the most likely focus in 2 of 7 episodes. Antimicrobial therapy commonly included cefepime or ampicillin-sulbactam for M. osloensis and cefotaxime or ampicillin-sulbactam for M. catarrhalis. The median duration of antimicrobial therapy was 14 days in both groups. No patients required pediatric intensive care unit (PICU) care and no 28-day mortality occurred.

Conclusion: The patients with bacteremia due to M. osloensis or M. catarrhalis had favorable clinical outcomes.

Background: Prostaglandin E-major urinary metabolite (PGE-MUM) is an emerging noninvasive biomarker used to evaluate clinical and endoscopic activity in patients with inflammatory bowel disease. Previous studies have shown that PGE-MUM values correlate with colonic inflammation in pediatric ulcerative colitis; however, reference values for children without inflammation have not been defined yet. This study aimed to determine the normal reference values of PGE-MUM in healthy pediatric subjects without inflammatory conditions.

Methods: Between December 2018 and January 2022, we prospectively enrolled 221 participants (cross-sectional study, aged 0-15 years) who were undergoing growth hormone stimulation testing for diagnostic purposes and exhibited no symptoms of inflammation or elevated C-reactive protein levels at a single pediatric center in Japan. PGE-MUM values were measured using a chemiluminescent enzyme immunoassay and assessed for age- and sex-related differences.

Results: A total of 218 participants were included in the analysis. Based on age, the participants were classified as young children (2-6 years, n = 147) and older children (7-14 years, n = 66); the reference ranges for the two groups were identified as 18.4-58.7 μg/g·Cr and 12.4-50.3 μg/g·Cr, respectively. The PGE-MUM values tended to decrease with increasing age; however, no significant sex-related differences were observed (median 29.1 μg/g·Cr for boys versus 30.4 μg/g·Cr for girls).

Conclusions: Healthy pediatric subjects generally have higher PGE-MUM values than healthy adults, with particularly elevated values in young children (2-6 years). These observations suggest that age-related variability must be taken into account when using PGE-MUM as a biomarker in young children with ulcerative colitis.

Background: Tracheomalacia, a common condition in neonates and children, is often associated with prematurity and prolonged mechanical ventilation. We aimed to investigate the characteristics of pulmonary function tests (PFTs) performed before extubation in preterm infants with subsequent diagnosis of tracheomalacia.

Methods: We retrospectively analyzed 44 preterm infants who underwent pre-extubation PFTs and subsequent flexible fiberoptic bronchoscopy (FFB) between April 2011 and May 2023. Nineteen infants were diagnosed with tracheomalacia by FFB (tracheomalacia group) and compared with 25 infants without the diagnosis (nontracheomalacia group). Tracheomalacia was defined as tracheal collapse during expiration with an increased ratio of the posterior membranous wall to tracheal cartilage observed during FFB. We compared patient characteristics and pulmonary function parameters, including static respiratory compliance (Crs) and crying vital capacity (CVC), between the two groups.

Results: The tracheomalacia group had significantly lower gestational age and birth weight. Pre-extubation Crs was significantly higher in the tracheomalacia group (1.23 vs. 0.97 mL/cmH₂O/kg, p < 0.05), while CVC and maximal inspiratory pressure did not differ significantly.

Conclusion: Preterm infants who were subsequently diagnosed with tracheomalacia exhibited higher Crs before extubation. Pre-extubation Crs may be a potential predictor for the subsequent development of tracheomalacia in this population.

Objective: Breast milk provides optimal nutrition for infants, with exclusive breastfeeding recommended for the first 6 months of life. Education during birth hospitalization is vital to promote exclusive breastfeeding. However, standardized references for neonatal weight loss rates based on data including national representative, multi-hospital, with different policies remain unavailable.

Methods: Data of 4774 participants from 146 hospitals throughout Japan were obtained from the national growth survey. Among them, 3302 were eligible for the analysis. Daily exclusive breastfeeding rates and their associations with facility and individual characteristics during birth hospitalization were then analyzed. Additionally, weight loss percentile reference curves by delivery mode were established using the Lambda-Mu-Sigma method.

Results: The rate was 60.8% on day 0 and plateaued at approximately 25% on day 3. Being born in a facility with high exclusive breastfeeding rate (odds ratio [OR]: 333.3, 95% confidence interval [CI]: 15.2-7142, p < 0.0001), multiparity (OR: 1.9, 95% CI: 1.4-2.5, p < 0.0001), vaginal delivery (OR: 2.2, 95% CI: 1.6-3.1, p < 0.0001), and lower weight loss rate on day 3 (OR: 1.2, 95% CI: 1.1-1.2, p < 0.0001) were identified as independent factors, and facility-level differences accounted for 58.4% of the total variability for exclusive breastfeeding at discharge. Using the data from 831 neonates with exclusive breastfeeding at discharge, weight loss rate references were established.

Conclusion: This study revealed Japan's nationwide daily exclusive breastfeeding rates during birth hospitalization and their significant influencing factors. The established references may be useful in promoting exclusive breastfeeding clinically.

Background: The implementation of the antimicrobial stewardship program (ASP) has become a standard practice aimed at optimizing antimicrobial prescriptions to prevent further development of drug-resistant organisms. However, the challenges faced in long-term care facilities (LTCFs) often present a scarcity of human resources crucial for the effective implementation of ASP initiatives. Our study was to evaluate the impact of feasible ASP in the LTCF.

Methods: A quasi-experimental study was conducted at the Tokyo Metropolitan Fuchu Medical Center for the Disabled serving as a LTCF in Japan. The pre- and post-intervention periods were from April 2013 to March 2018 and from April 2018 to March 2019, respectively. Multidisciplinary ASP, including periodic educational interventions, utilization of internal treatment manuals, pre-authorization, and prospective audit and feedback on prescribing practices, was administered by the infectious diseases team from the Tokyo Metropolitan Children's Medical Center. We compared days of antimicrobial therapy (DOT) and resistance rates between the pre- and post-intervention phases.

Results: Following the intervention, there was a noteworthy decline in the use of oral broad-spectrum antimicrobials (macrolides, fluoroquinolones, and third-generation cephalosporins), demonstrating a statistically significant level of change (p < 0.05). Throughout the study period, resistance rates of Escherichia coli and Pseudomonas aeruginosa to meropenem and levofloxacin remained largely stable, with no notable changes observed.

Conclusion: In this study, extending the expertise of antimicrobial stewardship from an adjoining acute-care facility to a LTCF was associated with a 42% reduction in the use of oral broad-spectrum antimicrobials.

Background: Clinical manifestations of Chédiak-Higashi syndrome (CHS), an autosomal recessive disorder caused by LYST gene variants, include immunodeficiency and neurologic deficits. This study investigated the effects of defective LYST on neurodegenerative features by the morphological analysis of organelles in dopaminergic neurons differentiated from induced pluripotent stem cells (iPSCs) derived from CHS patients.

Methods: iPSCs derived from CHS patients were analyzed by immunostaining with antibodies against microtubule-associated protein 2 and tyrosine hydroxylase, periodic acid-Schiff (PAS) staining, electron microscopy, and staining with a fluorescent probe to monitor autophagy.

Results: iPSC-derived neurons contained PAS-positive giant granules and lipofuscin-like granules. Electron microscopy revealed enlarged lysosomes with electron-dense granules and filament-like structures. The number and brightness of autophagosomes and autolysosomes were markedly increased in CHS iPSC-derived neurons under basal culture conditions. CHS iPSC-derived neuronal mitochondria were enlarged, polymorphic, and hypertrophic.

Conclusions: CHS iPSC-derived neurons contained abnormal organelles, including lysosomes, autophagosomes, and mitochondria, which may be related to the neurodegenerative features of CHS.